Pre-Qualification Authorization
Please fill in the spaces below and mail or fax us the application.
credit@windsetcapital.com or Fax: 1-855-631-0107
Business Information
Business Legal Name:
Business Address:
Phone:
Cell Phone:
Email:
Type of Business:
Business Entity:
Corp
LLC
LLP
Business DBA Name:
City:
State:
Zip:
Fax:
Website:
Tax ID (TIN) #:
Time in Business:
Amount of Working Capital Requested:
Partnership
Sole Prop
Landlord/Mortgage Information - REQUIRED
Landlord/Mortgage Company:
Rent/Mortgage Payment:
Landlord Contact Name:
Landlord Contact Phone:
Rent/Own?:
If Rented, Lease Start Date?:
Lease Term?:
Landlord Fax #:
Owner(s) Principal(s) Information
Name (Primary Owner):
Title:
% of Ownership:
Date of Birth:
Address:
City:
State:
Zip:
Home Phone:
SSN#:
Annual Income:
Drivers License # and State of Issue:
Name (2nd Owner):
Title:
% of Ownership:
Date of Birth:
Address:
City:
State:
Home Phone:
SSN#:
Annual Income:
Drivers License # and State of Issue:
Zip:
Funding Information - REQUIRED
Gross Annual Revenues: $
Monthly Credit Card Sales: $
Average Monthly Revenues: $
Do you have an open Cash Advance at this time:
Yes
No
If ‘Yes’ list the cash advance provider and balance: $
The Merchant and Owner(s)/Officer(s) identified above (individually, an “Applicant”) each represents, acknowledges and agrees that
(1) all information and documents provided to Channel Partners LLC (“CPL”)/Windset Capital Corporation are true, accurate and
complete, (2) Applicant will immediately notify CPL/Windset Capital Corporation of any change in such information or financial
condition, (3) Applicant authorizes CPL/Windset Capital Corporation to disclose all information and documents that CPL/Windset
Capital Corporation may obtain including credit reports to other persons or entities (collectively, "Assignees") that may be involved
with or acquire commercial loans having daily repayment features and/or purchase of receivables transactions, including without
limitation the application therefor (collectively, "Transactions") and each Assignee is authorized to use such information and
documents, and share such information and documents with other Assignees, in connection with potential Transactions, (4) each
Assignee will rely upon the accuracy and completeness of such information and documents, (5) CPL/Windset Capital Corporation,
Assignees, and each of their representatives, successors, assigns and designees (collectively, “Recipients”) are authorized to request
and receive any investigative reports, credit reports, statements from creditors or financial institutions, verification of information, or
any other information that a Recipient deems necessary, (6) Applicant waives and releases any claims against Recipients and any
information-providers arising from any act or omission relating to the requesting, receiving or release of information, and (7) each
Owner/Officer represents that he or she is authorized to sign this form on behalf of Merchant.
Primary Owner Signature: _______________________________________________ Date: _____________________________
2nd Owner Signature: __________________________________________________ Date: _____________________________
50 West Broadway, Suite 1006, Salt Lake City, UT 84101 | info@WindsetCapital.com | Phone: 855-761-8299 |Fax: 1-855-631-0107